Provider Demographics
NPI:1922132356
Name:SALZ, DOREEN RAE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:RAE
Last Name:SALZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11633 KILLIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1509
Mailing Address - Country:US
Mailing Address - Phone:818-366-5728
Mailing Address - Fax:
Practice Address - Street 1:3855 ALAMO ST
Practice Address - Street 2:SUITE 2032
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2103
Practice Address - Country:US
Practice Address - Phone:805-527-5856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS154311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical